Savings, Service, and Sensitivities in Rural New York
This article delves into the experience of cross-jurisdictional sharing in rural New York, highlighting the programmatic, fiscal, and political environments at the national, state, and local levels. It explores the challenges and opportunities faced by local health departments and the need for collaboration in the current public health landscape.
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Presentation Transcript
Savings, Service and Sensitivities: The Rural New York Cross Jurisdictional Sharing Experience Donald W. Rowe, PhD Director Office of Public Health Practice, University at Buffalo, State University of New York Paul Pettit, MSL Public Health Director Genesee and Orleans County
Background Programmatic and fiscal environment National State Local
National View Politics Continued downward trend in money and resources Annual uncertainty with funding streams Large difference in delivery system from state to state Accreditation - focus
New York State View Politics NYS structure State DOH, regional/district offices, county LHDs State adopts/sets direction carried out LHDs New focus by NYS Health Commissioner Provide reimbursements/funding to Counties Grants, article 6 state aid
Local Health Department View Shrinking county budgets NYS tax cap Focus on mandates Limited capacity for add-on's Reducing direct service delivery Certified Home Health Agencies County run nursing homes Mental health clinical services 2014 NYS budget tax rebates tied to staying with cap and shared services County Collaboration efforts - Healthy Orleans Network
Need for Collaboration background to Cross Jurisdictional Sharing Current Federal, State & local environment Limited resources on the ground Philosophical shift facilitators vs. doers New reality for government including Public Health
RWJF Shared Services Learning Community Grant Two year study (2013-14) through the Kansas Institute focused on cross jurisdictional activities in public health 75 public health departments and 26 local and state governments - explore ways to share resources with the goal of providing more efficient and effective public health services $125,000 over to two years to study cross jurisdictional services (CJS) across geographical barriers 3 - on site project meetings & site visits at each participating project Applied through Lake Plains Community Care Network
RWJF Cross Jurisdictional Sharing Grant 16 sites were identified and accepted into the project Notified of award in early December 2012 National Announcement released January 31st.
Definitions Cross-jurisdictional sharing is the deliberate exercise of public authority to enable collaboration across jurisdictional boundaries to deliver essential services. Collaboration means working across boundaries and in multi- organizational arrangements to solve problems that cannot be solved or easily solved by single organizations or jurisdictions.* *Source: Rosemary O Leary, School of Public Affairs and Administration, University of Kansas
12 Cross-Jurisdictional Sharing Spectrum Shared Functions with Joint Oversight Informal and Customary Arrangements Service Related Arrangement Regionalization Joint projects addressing all jurisdictions involved Shared capacity Inter-local agreements New entity formed by merging existing LHDs Consolidation of 1 or more LHD into existing LHD Service provision agreements Mutual aid agreements Purchase of staff time Handshake MOU Information sharing Equipment sharing Coordination
A Tool For Sharing A roadmap to develop cross-jurisdictional sharing (CJS) initiatives Developed by the CSPHS Based on what we have learned from your projects (and other published material) Also available at: http://www.phsharing.org/technical-assistance/
Next Step 14
Genesee & Orleans PILOT Agreements put in place in September for October 1, 2012 start date Sharing PHD, Deputy PHD/Environmental Health Director Notification of RWJF grant came in November 2012 First quarter learning systems, cultures, getting our feet wet Move to RWJ grant overlap of the projects
Year 1 Focus on programmatic and fiscal savings Brought on board nursing director (now 3 shared staff) Reduced travel to meetings (1 covering both) Sharing educational messaging Aligning policies, fee schedules, local sanitary codes Sharing consulting services (medical, engineering, transportation) 2 joint Boards of Health meetings
Return on Investment year 1 Quantitative Over $400,000 saved between the two counties Includes splitting costs of 3 administrative positions Shared travel expenses Consulting services CDC PHAP associate
Return on Investment Year 1 Qualitative Coordination of public health education and community messaging including joint Community Health Assessment / Community Health Improvement Plan Joint Purchasing / Vendors cost reports Program changes septic program alignment (in Orleans theoretical savings of $185,000) Sharing interns between the counties
*Shared staffing estimates consists of both salary and benefits CJS Fiscal impact/Savings to date Genesee County Enhanced Benefits/ Savings Orleans County Enhanced Benefits/ Savings Annual Enhanced Benefits/ Savings Total Enhanced Benefits/ Savings to Date (from 10/1/12) Criteria Description Public Health Director $66,000 $66,000 $396,000 Shared Staffing* $132,000.00 $34,506 $34,506 $69,011 $86,264 Emergency Preparedness Coordinator $41,790 $41,790 $83,581 $20,895 Director of Children with Special Needs $21,941 $0 $21,941.00 $65,823 Environmental Health Director $51,000 $51,000 $102,000.00 $178,500 Director of Community Health Services PHD Travel Expenses Savings $513.89 $651.89 $1,165.78 $2,332 Attending conferences, education and training $0 $56,375 Sharing Medical and Environmental Engineering Consultation Savings Existing Genesee County consultation being shared with Orleans County Medical: $7,500 $20,500.00 Environ: $13,000 CDC PHAP Associate Benefit $21,843.1 $21,843.1 $87,372 Assist both counties with research/analysis. Provided and paid for by CDC $43,686.23 $295,052 Shared Transportation Savings Joint RFP for Early Intervention and 3-5 Preschool Transportation $0 $107,291.61 $107,291.61 Total $1,188,613 $ 428,584.62
Service Shared medical director Shared environmental engineering consultant Shared training Shared Early Intervention transportation Shared public health education Shared emergency response functions Joint Community Health Assessments Shared governance Increased service efficiency
Sensitivities Political change Cultural differences State continued support Maintaining autonomy Funding Regulatory Separate collective bargaining units
Necessities for Successful Sharing Clarity of objectives Present and acceptance of mutual benefit Decision maker buy in & commitment difficult with changing leadership Strong leadership skills change management Transparency TRUST
Factors / Barriers to Sharing CHANGE! Cultural differences in each organization Buy in of staff leadership and workers Logistics - Reduced physical presence by shared staff Keeping decision makers happy & informed burnout
Summary Savings exceeding $1,000,000 No loss of Service No person has lost their job Significant increase in efficiency Sustainable for the foreseeable future Model has broad rural health application
Contact For additional information please contact Paul Pettit, Public Health Director, Genesee and Orleans Counties Paul.Pettit@orleanscountyny.gov
Acknowledgement The Robert Wood Johnson Foundation The New York State Department of Health The Lake Plains Community Care Network The University at Buffalo School of Public Health and Health Professions
Thank You Questions?
